Perineural Invasion in Extrahepatic Cholangiocarcinoma: Prognostic Impact and Treatment Strategies

Murakami, Yoshiaki; Uemura, Kenichiro; Sudo, Takeshi; Hashimoto, Yasushi; Kondo, Naru; Nakagawa, Noritoshi; Muto, Takeshi; Sasaki, Hayato; Urabe, K; Sueda, Taijiro

doi:10.1007/s11605-013-2251-0

Cited by 51 publications

(40 citation statements)

References 36 publications

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“…The prognostic effects of perineural invasion for patients with extrahepatic cholangiocarcinoma have been determined, showing that patients with perinerual invasion had worse prognoses relative to those who were negative in univariate but not multivariate analyses [23]. In our study, perineural invasion was not associated with the prognosis for pCCA patients, which may be due to the fact that extensive autonomic nerve dissection was performed for those patients.…”

Section: Discussionmentioning

confidence: 48%

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Chen

Zhu

et al. 2016

Oncotarget

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As the conventional staging systems have poor prognosis prediction ability for patients with perihilar cholangiocarcinoma (pCCA), we established and validated an effective prognostic nomogram for pCCA patients based on their personal and tumor characteristics. A total of 235 patients who received curative intent resections at the Eastern Hepatobiliary Surgery Hospital from 2000 to 2009 were recruited as the primary training cohort. Age, preoperative CA19-9 levels, portal vein involvement, hepatic artery invasion, lymph node metastases, and surgical treatment outcomes (R0 or R1/2) were independent prognostic factors for pCCA patients in the primary cohort as suggested by the multivariate analyses and these were included in the established nomogram. The calibration curve showed good agreement between overall survival probability of pCCA patients for the nomogram predictions and the actual observations and the concordance index (C-index) was 0.68 (95% CI, 0.61-0.71). The C-index values and time-dependent ROC tests suggested that the nomogram is superior to the conventional staging systems including the Bismuth-Corlette, Gazzaniga, Memorial Sloan Kettering Cancer Center (MSKCC), American Joint Committee on Cancer (AJCC) TNM 7 th edition, and Mayo Clinic. The nomogram also performed better than the traditional staging system in the internal cohort with 93 pCCA patients from the same institution and an external validation cohort including 84 pCCA patients from another institution in predicting the overall survival of the pCCA patients as suggested by the C-index values and the time-dependent ROC tests. In summary, the proposed nomogram has superior predictive accuracy of prognosis for resectable pCCA patients.

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Section: Discussionmentioning

confidence: 48%

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Chen

Zhu

et al. 2016

Oncotarget

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“…The TNM staging system is the only pCCA classification that is specifically developed for predicting survival (10). It was updated in 2010 and shown to have better predictive performance than the prior version (25) ; however, other studies reported that the current TNM staging system was not associated with the overall survival of pCCA patients undergoing surgical resection (24,26). Recently, a new staging system for pCCA has been proposed, which includes consideration of the severity of underlying liver disease and detailed information on tumor extent and vascular involvement, but again it relies on findings from surgical pathology, and its correlation with survival has not been examined (27).…”

Section: Discussionmentioning

confidence: 99%

A New Clinically Based Staging System for Perihilar Cholangiocarcinoma

Chaiteerakij

Harmsen

Marrero

et al. 2014

American Journal of Gastroenterology

108

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OBJECTIVES Current staging systems for perihilar cholangiocarcinoma (pCCA) are inadequate, as they are based on surgical pathology and therefore not relevant to unresectable patients. Clinical trials for potential targeted therapies for pCCA are hampered by the lack of an accurate, nonoperative staging system for predicting survival. We aimed at developing a clinical staging system for pCCA, which would be of prognostic relevance for all pCCA patients and help stratify patients for clinical trials. METHODS Clinical information at the time of pCCA diagnosis of 413 patients seen at Mayo Clinic, Rochester, MN between 2002 and 2010 was retrospectively analyzed. A survival predictive model was developed using Cox proportional hazards analysis. The performance of the staging system was compared with the current AJCC/UICC (the American Joint Committee on Cancer/the Union for International Cancer Control) 7th tumor-node-metastasis (TNM) staging system. RESULTS Eastern Cooperative Oncology Group (ECOG) status, tumor size and number, vascular encasement, lymph node and peritoneal metastasis and CA 19-9 level were grouped into a four-tier staging system. The median survivals of stages I, II, III, and IV patients were 48.6, 21.8, 8.6, and 2.8 months, with hazard ratios (95% confidence interval) of 1.0 (reference), 1.7 (1.1–2.6), 3.1 (2.0–4.7), and 8.7 (5.2–14.5), respectively (P<0.0001). This staging system had greater concordance statistics (standard error) than the TNM staging system (0.725 (0.018) vs. 0.614 (0.017)), indicating better performance in predicting survival. CONCLUSIONS This staging system, based on nonoperative information at the time of pCCA diagnosis, has excellent discriminatory power to classify patients into four prognostic stages. It could be useful to clinicians and for the design of clinical trials.

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“…The American Joint Committee on Cancer (AJCC) staging system is widely used for cancer classification, including pCCA, and it has been shown to predict the survival rate for resectable pCCA. However, a validation study failed to show a close association between predicted survival with grade in patients with resectable pCCA (17). A new staging system was developed that included 5 nonoperative variables and was found to be superior to the AJCC staging system for predicting survival in patients with pCCA (18).…”

mentioning

confidence: 99%

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

et al. 2016

Journal of Vascular and Interventional Radiology

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Perineural Invasion in Extrahepatic Cholangiocarcinoma: Prognostic Impact and Treatment Strategies

Abstract: Perineural invasion is a potent prognostic factor in extrahepatic cholangiocarcinoma. Adjuvant chemotherapy may improve the overall survival of patients with perineural invasion.

Cited by 51 publications

References 36 publications

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

A New Clinically Based Staging System for Perihilar Cholangiocarcinoma

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

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